Joshua Candamo, PhD’s Post

UnitedHealth Group CEO Andrew Witty has pushed back against the "vitriolic media and commentary" aimed at the health insurer and its slain executive in the wake of Brian Thompson's murder. Witty, in a video addressing employees, justified the insurer's denial practices as a vital function of the larger healthcare system. "Our role is a critical role, and we make sure that care is safe, appropriate, and it's delivered when people need it," Witty said. "We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable." A recent report by the U.S. Senate Permanent Subcommittee on Investigations highlighted UnitedHealthcare's use of AI to deny claims and found that the insurer's prior authorization denial rate for post-acute care jumped from 10.9% in 2020 to 22.7% in 2022. Thompson was named CEO in April 2021. "The mission of this company is truly to make sure that we help the system improve by helping the experience for individuals get better and better," Witty said. "There was nobody who did more to try and advance that mission than Brian Thompson. There are very few people in the history of the U.S. healthcare industry who had a bigger positive effect on American healthcare than Brian." The video of Witty has fanned the flames in online communities, where people have taken issue with the CEO's comments while continuing to criticize UnitedHealthcare and insurers in general, as well as the healthcare system overall. HealthLeaders #CEO #healthinsurance #payers

Luigi Mangione's alleged murder of UnitedHealthcare CEO Brian Thompson has sparked intense debate about America's healthcare system. As someone who has navigated its complexities firsthand, I'd like to share my perspective. My family's journey through the U.S. healthcare system has been harrowing. We've faced the crushing financial burden of caring for a terminally ill parent, pushing us to seek innovative, out-of-network treatments that drained our savings. More recently, the cost of care for our severely disabled child reached nearly $6 million in 2013-14 dollars (her first year of life) - a figure that dwarfs even the highest published estimates for lifetime care. These experiences have given me a nuanced view of our healthcare system's challenges: While Mangione's frustration is understandable, his actions and oversimplified view ignore the system's complexities. Health insurers, often vilified, play a multifaceted role. With profit margins of around 6% for major players like UnitedHealthcare, they're hardly the profit machines of companies like Apple or Microsoft. Systemic issues extend beyond insurers, including provider practices, administrative burdens, and structural problems like doctor shortages. The financial impact on families dealing with severe disabilities or terminal illnesses often far exceeds what studies and policies account for and are frequently not even a part of the conversation. Reform requires addressing inefficiencies across the entire system, not just insurance practices. As a health system-focused doctor who pushes for potentially expensive innovations, I also have to adjust my perspective. Mangione's case has resonated with those who've struggled with medical bills and what we might refer to as gaslighting from administrators (or at least the caricature of administrators). However, it's crucial to recognize that real change demands informed dialogue and comprehensive reform, not extreme actions. As we continue this vital conversation, let's strive for a balanced perspective that considers all stakeholders - patients, providers, insurers, and policymakers. Only through this approach can we hope to create a more equitable, efficient, and compassionate healthcare system for all Americans. #HealthcareReform #PatientAdvocacy #ChronicIllness #RareDisease #HealthcarePolicy Thoughts? I'd like to hear your experiences and perspectives on this complex issue.

Like my friend Samantha Shapiro highlights below 👇 - Payors are using AI and modern technology to deny your claims rapidly and in mass - WHY AREN'T YOU, TO WORK CLAIMS AND FIX DENIALS? By partnering with Athelas we can do just that TOGETHER! 🤝

"The United Healthcare CEO killing shines a light on the relationship between business, technology and humanity. I must say, even I was caught off guard to learn that an AI algorithm (and not humans) is evaluating and denying health insurance claims. A lawsuit filed in 2023 by the families of former beneficiaries alleges that United Healthcare knew that the AI being used had a 90% error rate but continued to use it anyway because a higher denial rate meant higher profits generated. United Healthcare denied an astonishing 30% of claims last year compared to Kaiser Permanente, for example, another big healthcare insurer that denied just 7% of claims. AI is essentially being used to rip people off! Deceitfully allowing these types of companies to get away with it because they can pass the blame onto the machine for denials and not taking any responsibility—a conscious-free way to even bigger profits." - Perry Douglas Read more here: https://lnkd.in/gbc2WZbA

🚨Hospitals are Facing More Insurance Denials — AI Is Key to Tackling the Problem🚨 A recent Newsweek article highlights a rising challenge for healthcare providers: increasing insurance claim denials, driven by AI systems used by insurers. This is leading to more administrative burdens and delays in patient care. 💡 At Athelas, we’re using AI to turn the tide. Our solutions streamline the insurance process, accelerate approvals, and reduce administrative strain, helping providers focus on what matters most: patient health. 🔗 Check out the full article to learn more about the issue and how AI is transforming healthcare. https://lnkd.in/du6Ais5j #HealthTech #AIinHealthcare #InsuranceDenials #Athelas #PatientCare #HealthcareInnovation

"In an October 2 conversation with Newsweek, Chandler Barron, president of Parathon (a revenue cycle management vendor that provides denials management services to health systems), suggested that more clarity on the insurance companies' algorithms could be useful. Today, there's little transparency about how AI is being used to deny claims. If health systems could see the AI model's scorecards, at least they'd know what they're up against, according to Barron." #Denials #RevenueRecovery #AIDenials #Parathon #Newsweek #InsuranceDenials

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. But the insurance companies don’t always make these decisions. Instead, they often outsource medical reviews to a largely hidden industry that makes money by turning down doctors’ requests for payments, known as prior authorizations. EviCore uses an algorithm backed by artificial intelligence, which some insiders call ‘the dial,’ that it can adjust to lead to higher denials. Some contracts ensure the company makes more money the more it cuts health spending. And it issues medical guidelines that doctors have said delay and deny care for patients. Learn more here: https://loom.ly/QmElcqE

1. The insurance industry, particularly health care companies, is criticized for treating patients as mere numbers rather than individuals in need of care. 2. The recent death of UnitedHealthcare’s CEO sparked public outrage, highlighting the dehumanizing practices of health insurers. 3. Health insurance companies, like UnitedHealth Group, report substantial profits, raising concerns about their prioritization of profit over patient care. 4. A paper revealed that algorithms are used to systematically deny care, with insurers like Cigna denying claims without thorough review. 5. Cigna denied over 300,000 claims in two months, averaging only 1.2 seconds of review per case. 6. UnitedHealthcare’s flawed AI system results in 90% of denials being reversed on appeal, indicating a troubling denial process. 7. Insurers may delay care by forcing patients into lengthy appeals processes, often anticipating that patients will die before their claims are resolved. 8. The tragic death of Thompson symbolizes the anger towards a health care system perceived as profiting from human suffering, with AI being utilized in harmful ways.

Worth the read. What do you think? TLDR: To represent both sides of this debate, I found the following excerpts most helpful. "Here’s how it works, the former employees said: The algorithm reviews a request and gives it a score. For example, it may judge one request to have a 75% chance of approval, while another to have a 95% chance. If EviCore wants more denials, it can send on for review anything that scores lower than a 95%. If it wants fewer, it can set the threshold for reviews at scores lower than 75%." "EviCore salespeople have boasted of a 15% increase in denials, according to the investigation, which is based on internal documents, corporate data and dozens of interviews with former employees, doctors, industry experts, health care regulators and insurance executives." "In a response to questions, a Cigna spokesperson provided a statement on behalf of EviCore. “Simply put, EviCore uses the latest evidence-based medicine to ensure that patients receive the care they need and avoid the services they do not,” it said." https://lnkd.in/gTn6jteQ #priorauthorizations #healthcare #healthinsurance #transparency #patientasconsumer #patientempowerment #medicaldenials

Not that I condone murder of CEOs, but there are murders that ARE condoned. This type of use of AI will increasingly dominate the corporate business throughout the economy. A strive to escape responsibility. "UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors' judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan."